Monday, June 28, 2010

Medical Mondays: Saving the Human Popsicle

One of my characters falls through the ice far from civilization and is rescued but not before hypothermia sets in. Would she be confused about where she is and who she is? Memory loss? I've heard (and have written it so) that the best way to warm a victim after such trauma is to get them out of the wet clothes immediately and into a sleeping bag or under blankets, ideally with a healthy, warm individual who could best share their body warmth by disrobing and lying with the victim. Is this an accurate assumption? It makes for a steamy situtaion but I don't want to be too far off the logical track.

Steamy, indeed! But before the romantic body warming begins, let's talk about hypothermia.

Being immersed in near-freezing water, a human's chance of survival decreases the longer they're in it. So your character, assuming she needs to survive this catastrophe, would have to be in less than 20 minutes for the best chances possible.

Diving into cold water causes the "Mammalian Diving Reflex" which causes the blood in the body to be shunted to vital organs, namely the heart and brain. The heart rate will decreases and the blood vessels to the limbs constrict, keeping the warm blood circulating in the center part of the body.

With moderate hypothermia (core temperature of 82-90 degrees F) she might have a slow breathing rate, sleepiness and grogginess, the inability to shiver, and something called "paradoxical undressing."

As for the treatment?

With mild hypothermia, passive external rewarming is the treatment. It includes taking off any wet clothes and just bundling up the person in warm, dry clothes and letting their own bodies rewarm themselves.

With moderate hypothermia, you can do active external rewarming, namely stripping the victim down to the skivvies, and having a warm person do the same (steamy moment coming soon...) and have them make a human burrito in a sleeping bag.

Fan yourselves, readers!

The key is to rewarm the person's core, before you work on their extremities. If you rewarm the arms and legs first, that cold blood has a lot of acid in it from the poor circulation, and flushing the heart with that cold, acidic blood quickly can cause fatal arrhythmias.

For severe hypothermia, there is also passive internal rewarming, using warmed IV fluids and flushing the stomach and colon with warmed fluids. I know, I know. I'll say if for you. Eww. They can even flush the cavity surrounding your intestines and lungs too.

So Yvonne, you're all set for the scene. Except for the memory loss, which isn't a usual symptom, everything else looks good to go. It makes the best sense to make the romance happen that way. Why, he's saving her life after all!

Excellent.

Please keep in mind this post is for writing purposes only and is not to be construed as medical advice!

Love this! I am learning so much. I've got a scene where a guy goes onto a hot attic in Florida to replace a fuse and becomes disoriented, sweaty,chilled and can't move much--am I close? I know people have died in attics here due to the extreme temps. I have him rescued and given water and cooling cloths.

Thanks Lydia for featuring my question. I had also wondered about our natural instinct to warm hands and feet which in this case (moderate hypothermia) would be a mistake, and I now know that if my guy is an outdoorsman (which he is) he would probaby know this. It is true that some confusion would result though, right? I like the idea of a human burrito. I'm going to print out your response to stick in my file. Awesome information. Now back to the warming process.....

Hi Terri! That's a great question. I can tackle that next week if it's okay with you!

Hey Matthew,It's true, if the hypothermia is relatively severe, you can get confusion and disorientation, and some memory loss would occur with that. But there ought to be no permanent damage unless the brain suffered signs of lack of oxygen for a long time.

So cool! (No pun intended). I'm sure the medical background comes in very handy in writing. I know I use every bit of the psychology and theater from my past. Now I know where to go when I run into a medical dilemma in my WIP

Hi Olleymae,I always thought that Abyss scene was fascinating. Drowning yourself on purpose? It was (literally) a heart-stopping scene. I think in real life, it's possible, but incredibly risky. There's a huge chance that she might have just died. And there'd be a fear of permanent brain damage from the lack of oxygen.

Hi Giles,Paradoxical undressing is when the person, who is clearly cold, feels the need to shed their clothing instead of put more on to stay warm. It's a sign of confusion. Sounds weird, huh?

Hey Giles! Yes, maybe the instinct originally comes from the need to take off the wet clothing, though that instinct loses it usefulness if they're redressed in warm dry clothes. Although, if the clothing is wool, and it's in a remote area, you'd be better off keeping the cold clothes ON since wool insulates even when wet...Rambling thoughts, forgive me!

That was another great post! And the comment discussion is fabulous, too. I once did a news story on a guy who rescued some people on a mountain who were suffering hypothermia--and now I know, paradoxical undressing. They starting shedding clothes and laughing as he was trying to get them to get up and start down.

Hi Lydia! Thanks for joining my blog, I'm now a follower here too.I've been fascinated by this post in particular as it's always interesting to learn more medical facts that might help in other writing projects.

I had a medical question regarding heat stroke. How long does it generally take for the symptoms of heat stroke to show themselves. I know that in lots of people it's immediate but is it possible for the symptoms to not become obvious for an hour or two hours? Or that someone (another family member) might not notice the symptoms?

I've been at a handful of codes, and had to keep working on a patient who was hypothermic because as the saying goes, they aren't dead until they're warm and dead. I haven't seen it in awhile though, so maybe medical advice is changing regarding that? I had codes at two different hospitals like that, so it wasn't just one doctor.

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